Rojas Graciela, Fritsch Rosemarie, Solis Jaime, Jadresic Enrique, Castillo Cristóbal, González Marco, Guajardo Viviana, Lewis Glyn, Peters Tim J, Araya Ricardo
Hospital Clínico, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Lancet. 2007 Nov 10;370(9599):1629-37. doi: 10.1016/S0140-6736(07)61685-7.
The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain. We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile.
230 mothers with major depression attending postnatal clinics were randomly allocated to either a multicomponent intervention (n=114) or usual care (n=116). The multicomponent intervention involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. Usual care included all services normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for specialty treatment. The primary outcome measure was the Edinburgh postnatal depression scale (EPDS) score at 3 and 6 months after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00518830.
208 (90%) of women randomly assigned to treatment groups completed assessments. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months (8.5 [95% CI 7.2-9.7] vs 12.8 [11.3-14.1]). Although these differences between groups decreased by 6 months, EPDS score remained better in multicomponent intervention group than in usual care group (10.9 [9.6-12.2] vs 12.5 [11.1-13.8]). The adjusted difference in mean EPDS between the two groups at 3 months was -4.5 (95% CI -6.3 to -2.7; p<0.0001). The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group (multicomponent intervention from 60/101 [59%; 95% CI 49-69%] to 38/106 [36%; 27-46%]; usual care from 18/108 [17%; 10-25%] to 11/102 [11%; 6-19%]).
Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in low-income settings, through multicomponent interventions. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.
在发展中国家，改善产后抑郁症识别与治疗的最佳方式尚不确定。我们比较了多组分干预与常规护理在智利圣地亚哥初级保健诊所治疗低收入母亲产后抑郁症的效果。
230名患有重度抑郁症且在产后诊所就诊的母亲被随机分配至多组分干预组（n = 114）或常规护理组（n = 116）。多组分干预包括一个心理教育小组、治疗依从性支持以及必要时的药物治疗。常规护理包括诊所通常提供的所有服务，如抗抑郁药物、简短心理治疗干预、医疗咨询或转介至专科治疗。主要结局指标是随机分组后3个月和6个月时的爱丁堡产后抑郁量表（EPDS）评分。分析采用意向性分析。本研究已在ClinicalTrials.gov注册，注册号为NCT00518830。
随机分配至治疗组的208名（90%）女性完成了评估。多组分干预组在3个月时的EPDS粗平均分低于常规护理组（8.5 [95% CI 7.2 - 9.7] 对比12.8 [11.3 - 14.1]）。尽管两组间的这些差异在6个月时有所减小，但多组分干预组的EPDS评分仍优于常规护理组（10.9 [9.6 - 12.2] 对比12.5 [11.1 - 13.8]）。两组在3个月时EPDS平均分的调整差异为 -4.5（95% CI -6.3至 -2.7；p < 0.0001）。干预组在3个月后服用抗抑郁药的女性人数减少幅度大于常规护理组（多组分干预组从60/101 [59%；95% CI 49 - 69%] 降至38/106 [36%；27 - 46%]；常规护理组从18/108 [17%；10 - 25%] 降至11/102 [11%；6 - 19%]）。
我们的研究结果表明，即使在低收入环境中，患有抑郁症且育有新生儿的低收入母亲也可通过多组分干预得到有效帮助。需要对该干预措施进行进一步优化，以确保急性期后治疗的依从性。
